An Introduction to Tourette Syndrome TSA Educational In-Service

1. An Introduction toTourette SyndromeTSA Educational In-Service

2. A Teacher’s Perspective I’ve come to the conclusion that I am the decisive element in the classroom. It’s my personal approach that creates the climate. It’s my daily mood that makes the weather. As a teacher, I possess a tremendous power to make a child’s life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or honor, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated and a child humanized or de-humanized. – Haim Ginott

3. About TSAwww.tsa-usa.org • Education • Briefings • Education • Advocacy • Publications • DVDs • Conferences • Public policy • Service • Information • Referrals • Fundraising • Local TSA Chapters • Newsletters • Research • Grants • Scientific Advisory Board (SAB) • Genetics • Clinical trials • Neuroimaging • Treatments There’s Room for YOU! Our Mission Is To Identify The Cause Of, Find The Cure For And Control The Effects Of Tourette Syndrome

4. Tourette Syndrome (TS) • Neuro-biological disorder • Genetic • Involuntary • More common than once thought • Symptoms involve both motor and vocal tics • Due to the nature of TS, symptoms will vary from person to person

5. “I Have Tourette’s, But Tourette’s Doesn’t Have Me” The Full Length DVD for This HBO Documentary is Available on the TSA Website

6. Motor Tics • Simple Motor Tics • Eye blinking, grimacing, nose twitching, leg movements, shoulder shrugs, arm and head jerks, etc. • Complex Motor Tics • Hopping, clapping, throwing, touching (self, others, objects) • Holding funny expressions, sticking out the tongue, kissing, pinching, tearing paper or books, etc.

7. Vocal Tics • Simple Vocal Tics • Whistling, coughing, sniffling, screeching, animal noises, grunting, throat clearing, etc. • Complex Vocal Tics • Linguistically meaningful utterances • Coprolalia (racial slurs, inappropriate language), repeating words/phrases • Speech Atypicalities • Unusual rhythms, tone accents, intensity of speech, stutter-like, immature voice

8. Tourette Syndrome Tics VideoCourtesy of Joseph Jankovic, MD

9. The Nature of Tics • Naturally wax and wane • Change in appearance and frequency • Change in severity and intensity • May worsen during adolescence • Can sometimes be suppressed for short periods of time

10. Environmental Factors May Impact TS Symptoms • Stress • Anxiety • Excitement • Fatigue • Holidays • Illness • Vacations • Hunger • Life & School Transitions

11. Possible Related Issues Social Skills Deficits Obsessions & Compulsions Executive Dysfunction TOURETTE SYNDROME Immaturity Handwriting Problems Sensory Processing ADHD Dysinhibition Sleep Issues Learning Disability Inappropriate Responses Anxiety/ Mood

12. Dysgraphia • Characteristics include • Slow and laborious writing • Hand and finger cramping • Sloppy handwriting, e.g., uneven spacing, irregular margins, and inconsistent lettering • Inability to copy correctly from book to paper or board to paper • Inability to transfer thoughts onto paper • Can be addressed with the use of computer technologies

13. Obsessive-Compulsive Disorder(OCD) and TS • Obsessions • Intrusive and recurring thoughts and images or impulses that your mind gets stuck on which are unpleasant and disrupt functioning • Compulsions • Behaviors that are used to reduce the anxiety accompanying the obsessions • OCD and TS share chronic waxing and waning • Exacerbated by stress, excitement and fatigue • OCD is often not apparent to the teacher or other students • OCD makes children feel isolated

14. Attention Deficit Hyperactive Disorder • A very large number of students with TS also have ADHD • They will sometimes, but not always • Be hyperactive • Be easily distracted • Be socially immature • Have impulse control problems • Exhibit short-term memory difficulties • Have problems with executive function

15. Examples Of Executive Dysfunction • Executive Dysfunction is often associated with ADHD • Difficulties include • Managing time • Forming goals • Organizing materials and activities • Starting/completing tasks • Breaking down long assignments and projects • Sequencing information • Dealing with the unexpected

16. What About Medication? Before Medication After Medication

17. Pledge Of Allegiance Experiential Exercise How Does Having TS Really Impact Classroom Performance And Learning?

18. IDEA 2004 & Federal Regulations 300.8(c)(9) “We believe that Tourette Syndrome is commonly misunderstood to be a behavioral or emotional condition, rather than a neurological condition. Therefore including Tourette Syndrome in the definition of other health impairment may help correct the misperception of Tourette Syndrome as a behavioral or conduct disorder and prevent the misdiagnosis of their needs.” Due to the intense advocacy efforts of the national Tourette Syndrome Association, TS is now included in the IDEA under the definition of Other Health Impaired

19. Classroom Strategies • Designate a safe place for the student to go to when tics are severe • Positive and proactive supports involving TS symptoms • Extended time for tests and assignments • Reduce stressful situations • Frequent breaks to provide opportunities for movement • Preferential seating • TS educational in-service for the entire school • TSA Youth Ambassador Program • Find ways to make tics irrelevant “Every child is different, therefore every child will require different strategies, BUT there is a strategy for every child.” Judit Ungar, President, Tourette Syndrome Association

20. Classroom Strategies (cont.) • Set up a signal for student to use when there is a need to leave the classroom • Un-timed tests and exams for all subjects • Allow student to leave class early to avoid crowded hallways • Build schedule around student’s most productive times of the day • Consider accommodations for written accomplishing work • Oral reports, use of a computer, shortened assignments, and/or a scribe • Consider additional adult support during unstructured time • Refer to TSA’s “Catalog of Accommodations”

21. Parent-Teacher Relationship • Homework support • Extra set of books for home use • Frequent communication between school and family • An informed, caring, and supportive environment makes all thedifference

22. Kids with TS Are Regular People Like You & Me • All walks of life & all professions • TS is an Equal Opportunity Disorder • Kids with TS are kids first • TS is life long and at this time, there is no cure • Symptoms can look controllable • But they are not!!

23. Additional Presentations • ADHD/Executive Functions • Obsessive Compulsive Disorder (OCD) • Factors That May Affect Learning

24. The Bottom Line Iwantto learn and do well in school! Will you help me?

25. Contact TSA for More Information and Resources • Tourette Syndrome Association, Inc. • 42-40 Bell Boulevard, Suite 205 • Bayside, New York 11361-2820 • Tel: (718) 224-2999 • Fax: (718) 279-9596 • Email: ts@tsa-usa.org • www.tsa-usa.org